Successful management of acute myeloid leukemia transformed from chronic myelomonocytic leukemia in the elderly by a combination regimen of decitabine and cytarabine, aclarubicin and granulocyte colony-stimulating factor: A case report

Deng,Qi; Li,Jing‑Yi; Liu,Peng‑Jiang; Zhao,Ming‑Feng

doi:10.3892/ol.2015.2870

Successful management of acute myeloid leukemia transformed from chronic myelomonocytic leukemia in the elderly by a combination regimen of decitabine and cytarabine, aclarubicin and granulocyte colony-stimulating factor: A case report

Authors:
- Qi Deng
- Jing‑Yi Li
- Peng‑Jiang Liu
- Ming‑Feng Zhao
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Affiliations: Department of Hematology, The First Central Hospital of Tianjin, Tianjin 300192, P.R. China
Published online on: January 13, 2015 https://doi.org/10.3892/ol.2015.2870
Pages: 1217-1220

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Abstract

Despite advances in the treatment of acute myeloid leukemia (AML) in recent years, the outcome of elderly AML patients with antecedent hematological disorders remains unsatisfactory. The present study describes a case of complete remission in an elderly patient with AML transformed from chronic myelomonocytic leukemia (CMML) and the treatment of the case with decitabine in combination with cytarabine, aclarubicin and granulocyte colony‑stimulating factor (CAG). A 70‑year‑old male was admitted with fever, pruritus and weakness that had been apparent for two weeks, and a two‑year history of monocytosis (22.5‑27.0%). Further examinations revealed a hemoglobin level of 106 g/l, a white blood cell count of 39.52x109/l, a platelet count of 81x109/l, Y chromosome loss and uniparental disomy on chromosomes 4q, 2q and 19p. The patient was diagnosed with AML transformed from CMML, with cytogenetic anomalies. A combination regimen of decitabine and CAG was administered. Subsequent to one cycle, the patient achieved complete remission. The patient was then followed up with three courses of the same regimen and achieved clinical remission, with no evidence of AML relapse. The present study suggests that a combination of low‑dose decitabine and CAG may offer a novel and potentially effective treatment regimen for elderly AML patients.

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1	Döhner H, Estey EH, Amadori S, et al: European LeukemiaNet: Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood. 115:453–474. 2010. View Article : Google Scholar
2	Dombret H, Raffoux E and Gardin C: New insights in the management of elderly patients with acute myeloid leukemia. Curr Opin Oncol. 21:589–593. 2009. View Article : Google Scholar : PubMed/NCBI
3	Lancet JE, Willman CL and Bennett JM: Acute myelogenous leukemia and aging. Clinical interactions. Hematol Oncol Clin North Am. 14:251–267. 2000. View Article : Google Scholar : PubMed/NCBI
4	Lin TL and Levy MY: Acute myeloid leukemia: focus on novel therapeutic strategies. Clin Med Insights Oncol. 6:205–217. 2012. View Article : Google Scholar : PubMed/NCBI
5	Ungewickell A and Medeiros BC: Novel agents in acute myeloid leukemia. Int J Hematol. 96:178–185. 2012. View Article : Google Scholar : PubMed/NCBI
6	Vardiman JW, Thiele J, Arber DA, et al: The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood. 114:937–951. 2009. View Article : Google Scholar : PubMed/NCBI
7	Grimwade D, Walker H, Oliver F, et al: The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML 10 trial. The Medical Research Council Adult and Children’s Leukaemia Working Parties. Blood. 92:2322–2333. 1998.PubMed/NCBI
8	Löwenberg B: Diagnosis and prognosis in acute myeloid leukemia - the art of distinction. N Engl J Med. 358:1960–1962. 2008. View Article : Google Scholar
9	Mohamedali A, Gäken J, Twine NA, et al: Prevalence and prognostic significance of allelic imbalance by single-nucleotide polymorphism analysis in low-risk myelodysplastic syndromes. Blood. 110:3365–3373. 2007. View Article : Google Scholar : PubMed/NCBI
10	Tiu RV, Gondek LP, O’Keefe CL, et al: New lesions detected by single nucleotide polymorphism array-based chromosomal analysis have important clinical impact in acute myeloid leukemia. J Clin Oncol. 27:5219–5226. 2009. View Article : Google Scholar : PubMed/NCBI
11	Bacher U, Haferlach T, Kern W, et al: Conventional cytogenetics of myeloproliferative diseases other than CML contribute valid information. Ann Hematol. 84:250–257. 2005. View Article : Google Scholar : PubMed/NCBI
12	Haase D, Germing U, Schanz J, et al: New insights into the prognostic impact of the karyotype in MDS and correlation with subtypes: Evidence from a core dataset of 2124 patients. Blood. 110:4385–4395. 2007. View Article : Google Scholar : PubMed/NCBI
13	Kohlmann A, Grossmann V, Klein HU, et al: Next-generation sequencing technology reveals a characteristic pattern of molecular mutations in 72.8% of chronic myelomonocytic leukemia by detecting frequent alterations in TET2, CBL, RAS, and RUNX1. J Clin Oncol. 28:3858–3865. 2010. View Article : Google Scholar : PubMed/NCBI
14	Orazi A and Germing U: The myelodysplastic/myeloproliferative neoplasms: myeloproliferative diseases with dysplastic features. Leukemia. 22:1308–1319. 2008. View Article : Google Scholar : PubMed/NCBI
15	Raghavan M, Smith LL, Lillington DM, et al: Segmental uniparental disomy is a commonly acquired genetic event in relapsed acute myeloid leukemia. Blood. 112:814–821. 2008. View Article : Google Scholar : PubMed/NCBI
16	Gondek LP, Tiu R, O’Keefe CL, et al: Chromosomal lesions and uniparental disomy detected by SNP arrays in MDS, MDS/MPD, and MDS-derived AML. Blood. 111:1534–1542. 2008. View Article : Google Scholar
17	Parikh SA and Tefferi A: Chronic myelomonocytic leukemia: 2012 update on diagnosis, risk stratification, and management. Am J Hematol. 87:610–619. 2012. View Article : Google Scholar : PubMed/NCBI
18	Kantarjian H, Oki Y, Garcia-Manero G, et al: Results of a randomized study of 3 schedules of low-dose decitabine in higher-risk myelodysplastic syndrome and chronic myelomonocytic leukemia. Blood. 109:52–57. 2007. View Article : Google Scholar
19	Steensma DP, Baer MR, Slack JL, et al: Multicenter study of decitabine administered daily for 5 days every 4 weeks to adults with myelodysplastic syndromes: the alternative dosing for outpatient treatment (ADOPT) trial. J Clin Oncol. 27:3842–3848. 2009. View Article : Google Scholar : PubMed/NCBI
20	de Lima M, Giralt S, Thall PF, et al: Maintenance therapy with low-dose azacitidine after allogeneic hematopoietic stem cell transplantation for recurrent acute myelogenous leukemia or myelodysplastic syndrome: a dose and schedule finding study. Cancer. 116:5420–5431. 2010. View Article : Google Scholar : PubMed/NCBI
21	Baer MR and Gojo I: Novel agents for the treatment of acute myeloid leukemia in the older patient. J Natl Compr Canc Netw. 9:331–335. 2011.PubMed/NCBI
22	Oki Y, Kondo Y, Yamamoto K, et al: Phase I/II study of decitabine in patients with myelodysplastic syndrome: a multi-center study in Japan. Cancer Sci. 103:1839–1847. 2012. View Article : Google Scholar : PubMed/NCBI
23	Blum W, Garzon R, Klisovic RB, et al: Clinical response and miR-29b predictive significance in older AML patients treated with a 10-day schedule of decitabine. Proc Natl Acad Sci USA. 107:7473–7478. 2010. View Article : Google Scholar : PubMed/NCBI
24	Yamada K, Furusawa S, Saito K, et al: Concurrent use of granulocyte colony-stimulating factor with low-dose cytosine arabinoside and aclarubicin for previously treated acute myelogenous leukemia: a pilot study. Leukemia. 9:10–14. 1995.PubMed/NCBI
25	Saito K, Nakamura Y, Aoyagi M, et al: Low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (CAG regimen) for previously treated patients with relapsed or primary resistant acute myelogenous leukemia (AML) and previously untreated elderly patients with AML, secondary AML, and refractory anemia with excess blasts in transformation. Int J Hematol. 71:238–244. 2000.PubMed/NCBI
26	Suzushima H, Wada N, Yamasaki H, et al: Low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor for elderly patients with previously untreated acute myeloid leukemia. Leuk Res. 34:610–614. 2010. View Article : Google Scholar